Vascularized versus non-vascularized bone grafts in the treatment of scaphoid non-union

Introduction: Conventional non-vascularized bone grafts as well as vascularized bone grafts are used to treat scaphoid non-union (SN). Due to limited available studies, the field of application using both grafts for SN still remains controversial. The aim of this study was to evaluate a treatment algorithm for the use of both vascularized versus non-vascularized bone grafts based on clinical outcomes and quality of life (QoL) to improve the level of evidence. Materials and Methods: Based on a retrospective cohort study, including 28 patients with vascularized and 45 patients with conventional bone grafts, functional parameters, radiological outcome, Mayo-wrist-score, and QoL by SF-36 were applied to statistically compare the outcome of these two techniques. Results: Time between last procedure or trauma and study group scaphoid reconstruction was almost double in the vascularized bone grafting group. Comparable union rates were achieved with vascularized as well as non-vascularized bone grafts. Significant differences were observed between both groups for grip strength and radial-ulnar active range of motion. Further functional outcomes, radiological outcomes as well as QoL were found similar for both techniques in patients with surgical union. Discussion and conclusions: In order to achieve comparable and appropriate treatment results, vascularized bone grafts are recommended for patients with delayed treatment, impaired scaphoid vascularity, and revision surgery. Even in preselected, complex cases, the results are comparable to conventional grafts, which are the basis for further patient education and approve the powerful role of surgical angiogenesis of vascularized bone grafts.

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Titanium template for scaphoid reconstruction

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193414549008 ◽

2014 ◽

Vol 40 (5) ◽

pp. 526-533 ◽

Cited By ~ 14

Author(s):

M. Haefeli ◽

D. J. Schaefer ◽

R. Schumacher ◽

M. Müller-Gerbl ◽

P. Honigmann

Keyword(s):

Clinical Case ◽

Three Dimensional ◽

Level Of Evidence ◽

Non Union ◽

Intraoperative Control ◽

Operative Planning ◽

Dimensional Shape ◽

Template Design ◽

Scaphoid Reconstruction ◽

Three Dimensional Shape

Reconstruction of a non-united scaphoid with a humpback deformity involves resection of the non-union followed by bone grafting and fixation of the fragments. Intraoperative control of the reconstruction is difficult owing to the complex three-dimensional shape of the scaphoid and the other carpal bones overlying the scaphoid on lateral radiographs. We developed a titanium template that fits exactly to the surfaces of the proximal and distal scaphoid poles to define their position relative to each other after resection of the non-union. The templates were designed on three-dimensional computed tomography reconstructions and manufactured using selective laser melting technology. Ten conserved human wrists were used to simulate the reconstruction. The achieved precision measured as the deviation of the surface of the reconstructed scaphoid from its virtual counterpart was good in five cases (maximal difference 1.5 mm), moderate in one case (maximal difference 3 mm) and inadequate in four cases (difference more than 3 mm). The main problems were attributed to the template design and can be avoided by improved pre-operative planning, as shown in a clinical case. Level of evidence: V

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Scaphoid fracture non-union: a systematic review of surgical treatment using bone graft

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415604778 ◽

2015 ◽

Vol 41 (5) ◽

pp. 492-500 ◽

Cited By ~ 31

Author(s):

D. O. Ferguson ◽

V. Shanbhag ◽

H. Hedley ◽

I. Reichert ◽

S. Lipscombe ◽

...

Keyword(s):

Systematic Review ◽

Bone Graft ◽

Study Design ◽

Scaphoid Fracture ◽

Vascularized Bone Graft ◽

Level Of Evidence ◽

Data Set ◽

Non Union ◽

Quality And Outcomes ◽

Vascularized Bone

This systematic review assesses the quality and outcomes of published articles concerning bone graft surgery for scaphoid fracture non-union. Searches of the CENTRAL, MEDLINE, EMBASE, CINAHL and AMED databases captured 2710 articles. Each article was screened and 144 met our inclusion criteria. Data regarding source, study design, population, intervention, comparator and outcomes were extracted. There were 5464 scaphoid non-union outcomes within the 144 studies. Mean reported union rates for vascularized and non-vascularized bone graft were 84% and 80%, respectively. Avascular necrosis was diagnosed in several ways and, when present, the vascularized bone graft union rate was 74% compared with 62% with non-vascularized bone graft. Reported union rates vary considerably. These differences may be due to patient factors, fracture factors, treatment factors or study design failures or bias. We recommend that future researchers take into account the deficiencies of previous studies and use the suggested minimum data set in future studies. Level of evidence: II

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Bone Grafts for Scaphoid Nonunion: An Overview

Hand Surgery ◽

10.1142/s0218810415400043 ◽

2015 ◽

Vol 20 (02) ◽

pp. 222-227 ◽

Cited By ~ 11

Author(s):

Steven E.R. Hovius ◽

Tim de Jong

Keyword(s):

Surgical Treatment ◽

Bone Graft ◽

Bone Grafts ◽

Good Position ◽

Vascularized Bone Graft ◽

Scaphoid Nonunion ◽

Non Union ◽

Non Surgical Treatment ◽

Vascularized Bone

The scaphoid is the most common fractured bone in the wrist. Despite adequate non-surgical treatment, around 10% to 15% of these fractures will not heal. Untreated scaphoid non-union can cause a scaphoid non-union advance collapse (SNAC), this is a progressive deformity and can cause degenerative changes in the wrist. Surgery is focused on achieving consolidation, pain reduction and a good position of the scaphoid while preventing osteoarthritis in the long-term. Surgery consists of reduction and fixation of the scaphoid with a non-vascularized or vascularized bone graft. An overview of the most used vascularized and non-vascularized bone grafts and their indications are presented.

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Scaphoid reconstruction with vascularized bone grafts from the distal radius

Journal of Hand and Microsurgery ◽

10.1007/s12593-009-0003-x ◽

2016 ◽

Vol 01 (01) ◽

pp. 50-53 ◽

Cited By ~ 5

Author(s):

Konstantinos Malizos ◽

Zoe Dailiana ◽

Sokratis Varitimidis ◽

Loukia Papatheodorou

Keyword(s):

Distal Radius ◽

Bone Grafts ◽

Scaphoid Reconstruction ◽

Vascularized Bone

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Vascularized bone grafts for post-traumatic defects in the upper extremity

Archives of Plastic Surgery ◽

10.5999/aps.2020.00969 ◽

2021 ◽

Vol 48 (1) ◽

pp. 84-90

Author(s):

Giovanna Petrella ◽

Daniele Tosi ◽

Filippo Pantaleoni ◽

Roberto Adani

Keyword(s):

Upper Extremity ◽

Bone Grafting ◽

Femoral Condyle ◽

Bone Grafts ◽

Bone Defects ◽

Tissue Loss ◽

Surgical Reconstruction ◽

Non Union ◽

Post Traumatic ◽

Vascularized Bone

Vascularized bone grafts (VBGs) are widely employed to reconstruct upper extremity bone defects. Conventional bone grafting is generally used to treat defects smaller than 5–6 cm, when tissue vascularization is adequate and there is no infection risk. Vascularized fibular grafts (VFGs) are mainly used in the humerus, radius or ulna in cases of persistent non-union where traditional bone grafting has failed or for bone defects larger than 6 cm. Furthermore, VFGs are considered to be the standard treatment for large bone defects located in the radius, ulna and humerus and enable the reconstruction of soft-tissue loss, as VFGs can be harvested as osteocutaneous flaps. VBGs enable one-stage surgical reconstruction and are highly infection-resistant because of their autonomous vascularization. A vascularized medial femoral condyle (VFMC) free flap can be used to treat small defects and non-unions in the upper extremity. Relative contraindications to these procedures are diabetes, immunosuppression, chronic infections, alcohol, tobacco, drug abuse and obesity. The aim of our study was to illustrate the use of VFGs to treat large post-traumatic bone defects and osteomyelitis located in the upper extremity. Moreover, the use of VFMC autografts is presented.

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Pedicled vascularized versus non‐vascularized bone grafts in the treatment of scaphoid non‐union: a meta‐analysis of comparative studies

ANZ Journal of Surgery ◽

10.1111/ans.16894 ◽

2021 ◽

Author(s):

Hanyu Zhang ◽

Jiaxiang Gu ◽

Hongjun Liu ◽

Chaoqun Yuan

Keyword(s):

Comparative Studies ◽

Meta Analysis ◽

Bone Grafts ◽

Non Union ◽

Vascularized Bone

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Treatment algorithm and treat to target

10.1093/med/9780198737582.003.0032 ◽

2018 ◽

Author(s):

Laura C. Coates ◽

Arthur Kavanaugh ◽

Christopher T. Ritchlin

Keyword(s):

Treatment Algorithm ◽

Treat To Target ◽

Level Of Evidence ◽

Treatment Algorithms ◽

Delayed Treatment ◽

Eular Recommendations ◽

The Metabolic Syndrome ◽

Collaborative Working ◽

Inflammatory Bowel ◽

The Impact

This chapter covers the evidence for treatment algorithms and treatment to target in PsA. Evidence for treatment algorithms including step up vs step down approaches to prescribing and early vs delayed treatment is discussed. EULAR recommendations for treating to target in SpA are outlined with a summary of the level of evidence available at that time. Key outcome measures that could be utilized as targets in PsA are reviewed with discussion of their merits and deficiencies. A detailed description of the first treat to target study in PsA is presented: the TICOPA study. The impact of comorbidities on treatment decisions is discussed, both related SpA conditions such as uveitis and inflammatory bowel disease, and non-SpA comorbidities such as the metabolic syndrome and liver disease. Finally, suggestions for translation into clinical practice are outlined, highlighting the need for multi-speciality collaborative working, full assessment of disease activity and subsequent optimal treatment.

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The Use of Doppler Ultrasound to Assess the Blood Flow of Pedicled Vascularized Bone Grafting for Scaphoid Nonunions

Journal of Wrist Surgery ◽

10.1055/s-0040-1712514 ◽

2020 ◽

Vol 09 (05) ◽

pp. 396-403 ◽

Cited By ~ 1

Author(s):

J. Terrence Jose Jerome ◽

Ilayaraja Venkatachalam

Keyword(s):

Blood Flow ◽

High Frequency ◽

Doppler Ultrasonography ◽

Power Doppler ◽

Bone Grafts ◽

Power Doppler Ultrasonography ◽

High Frequency Power ◽

Level Of Evidence ◽

Frequency Power ◽

Vascularized Bone

Abstract Objectives This study aims to assess the blood flow and the vascularity pattern across the newly bridged vascularized bone grafts for scaphoid nonunions using three-dimensional (3D) high frequency power Doppler ultrasonography and its role in the union. Materials and Methods A total of 26 patients with scaphoid nonunions were operated with 1,2-intercompartmental supraretinacular artery (ICSRA) graft. CT scan and 3D high frequency power Doppler ultrasonography were performed in all patients between 12 and 18 weeks, and its results were analyzed. Results Doppler ultrasonography confirmed the pulsatile flow and vascularity across the pedicle and vascularized bone graft incorporation into the scaphoid nonunion site. Conclusions 3D high frequency power Doppler ultrasonography is a simple, noninvasive, nonradiation, reproducible, and well-reliable diagnostic modality in assessing the blood flow and vascularity of the bone grafts used for scaphoid nonunions. Level of Evidence This is a Level IV study.

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